Iritis and spondyloarthropathy :(

[gonzinka]

Hello,

My name is Natalia and I live in Poland. I'm 31 years old and I hate my iritis falre-ups. Last year my left eye got sick and the doctors weren't able to treat it for almost a year. I took oral steroid - Dexamethasone for a month and steroid eye-drops for 12 months. I hated the oral steroid, as I gained weight and felt anxious all the time. After 6 months my right eye got sick. I didn't know what to do, luckily it was over after 6 weeks. My left eye got a flare-up again 2 months ago. I had two eye injections with adrenaline to widen my pupil (in hospital I was told that they don't do steroid eye injections in Poland). Right now I use eye drops only - steroid TobraDex (successfully reduced to 2 times a day) and Atropinum. My eye pressure is ok.

I am HLAB-27 positive and I have spodyloarthropathy that is being treated with Sulfasalazine (brand name Azulfidine in the USA) only. The X-ray showed II degree sacroilitis, however I feel fine and very rarely feel any back pain. Eye doctors here don't really know how to help me in a long run (their only idea is to give me oral steroids to be taken in small doses for the rest of my life), they say that the rheumatologists should treat me. Rheumatologists say that I should get the biological therapy, however it's not possible at the moment (complicated situation in my country's health system). They say that the Methotrexate might help, but I'm scared of taking it, as I would like to have kids in 3 or 4 years.

I started to read this forum hoping to find some answers and later on speak about the treatment possibilities with my doctors. I've read about the Celebrex here and I want to talk about it with my doctor - so far she said that I should use NSDAID's only tentatively when I happen to feel joint pain. My main question is about my vision. It gets worse, my left eye is -8 at the time and I kind of see worse when it gets dark. Is there a possibility that I will be able to do LASIK eye surgery in the future if the flare-ups won't happen too often? Do any of you use contact lenses during the months after the flare-up (lets say after you stop widening the pupil, but still use steroid drops)? I hate my glasses and I really would love to wear my contacts again - even if it would mean a strict hours regime.

Anyway, thank you so much for this forum!

Natalia

[Mike Bartolatz]

Welcome to the group!
DR Foster, the INTERNATIONALLY RENOWN EXPERT in the treament of iritis uses NSAIDS to treat HLA B27 related uveitis AND the ankylosing spondylitis related to this gene. other option is Difusinal or Naproxen both generic NSAIDS but they only block COX1 and not COX2.

if NSAID treatment fails, then one moves on to Methotrexate trying to avoid TNF A drugs (biologicals) until methotrexate fales. Sulfasalzine isn't a good choice to treat uveitis. Methotrexate, Azathiropine, Cellcept are much better choices and actually have a very good safety profile in Iritis and uveitis patients. read about safety of these meds in the British Journal Of Medicine article on this topic availabe in a link at this site.
usually one waits six months before trying to conceive with DMARD drugs.
all efforts to prevent conception need to be used while on DMARD drugs. the only drugs availabe during pregnancy are topical steroids and injectible steroids with oral reserved for last resort to protect vision that is going to be compromised if not treated.

one takes the NSAID at PRESCRIPTION strenght while still on steroids. one slowly stops the steroids and when one gets to 'off all steroids without inflammation'. one then starts the clock to 2 years on this regimen as it takes this long to retrain the immune system to stop attacking th eyes. if you flare up, then you move on to the DMARD class of medications starting with Methotrexte. one keeps increasing dose until one is off all steroids without inflammation. the clock ticks for two years with this as well.

Wish you the very best,
mike